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Congenital intestinal malrotation is an inborn malformation with an aberrant position of the intestines and fixation of the mesentery reported to manifest neonatally in 80%. However, in nonidentified cases symptoms can have lifelong onset.Twenty-one patients, 15-64 years, were investigated from 2000 onwards. All patients, except two, had intermittent abdominal pain and nutritionalproblems. Abdominal CT showed malrotation of the bowel. Eight patients had malformations of other organs including five in the CNS. Twelve patients had undergone earlier abdominal surgery.Ten patients were operated electively, whereas eight needed emergent surgical approach. In seventeen cases a Ladd'sprocedure was performed, with the bowel placed in a ‘non-rotation’ position. Moreover, embryonic Ladd's adhesions, necessitated dissection. One patient died shortly after an operation with totally ischemic small bowel caused by a volvulus. The three non-operated patients all chose to await more disabling symptoms. All operated patients were finally symptom released, however in three, not until a completing Ladd'sprocedure.In auditing investigation of chronic abdominal pain, the possibility of intestinal malrotation causing intermittent pain should be considered. Mid-gut volvulus may be a lifethreatening condition. When or ifprophylactically to operate malrotation with reasonable complaints, is still not obvious.